Provider Demographics
NPI:1275088304
Name:HUTCHISON, LESLEY (PTA)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:
Last Name:HUTCHISON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 DUNLAP RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:WV
Mailing Address - Zip Code:25033-7471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:101 CARRIAGE PT
Practice Address - Street 2:SUITE 202
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-1526
Practice Address - Country:US
Practice Address - Phone:304-634-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPTA 001497174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist